Dr. Dennis Culhane’s (above, right) work as a University of Pennsylvania professor of social policy has been instrumental in housing policy. His research led to a federal mandate to implement data systems for tracking homelessness so cities and states could receive funding from the U.S. Department of Housing and Urban Development.
Seen by many as the leading academic authority on homelessness, Culhane published a groundbreaking study in 2002 that followed 10,000 homeless people with serious mental illness in New York, half of whom got supportive housing, half of whom did not. In addition to the humanitarian arguments for supportive housing, the eight-year study illustrated an economic one, too.
“Certainly, the quality of life difference was enormous,” Culhane said. “From an economic perspective, those who were housed didn’t get hospitalized as often, they didn’t get arrested, and they weren’t in shelters — so they reduced their use of services such that it was almost a break-even situation.” The study has been replicated more than 50 times with similar results since his initial report.
In September, Culhane spoke at a D.C. fundraiser for Open Arms Housing, a local nonprofit that provides housing and services such as medical treatment and employment counseling to chronically homeless women. Street Sense Media interviewed Culhane about the path to ending homelessness. Open Arms Housing Executive Director Marilyn Kresky-Wolff joined the conversation.
Street Sense: What effect has HUD-mandated data collection had on the study of homelessness?
Dennis Culhane: We now see two types of homelessness: a small group of people who are homeless for long periods of time — a year or more — and a large group of people, about 85 percent of the population, that is homeless for relatively brief periods of time.
We call that chronic homeless population vs. crisis homeless population. Over time we’ve figured out that we have interventions that are well-suited to each of those populations.
For the folks that are experiencing chronic homelessness, the supportive housing programs are pretty successful. They run at about an 85 percent retention rate. They’re basically providing a permanent housing voucher plus support services that help people find housing, move in and get integrated with the community.
For the people experiencing crisis homelessness, we’ve developed a new intervention called rapid rehousing that helps people negotiate the crisis they are in; they may have had family conflict, a hospitalization, or a sudden loss of a job. Rapid rehousing is intended to be a crisis intervention program that helps get people back into an apartment or shared living arrangement as quickly as possible.
Marilyn Kresky-Wolff: Rapid rehousing is controversial in D.C. The Washington Legal Clinic for the Homeless is very much questioning whether it works. It is hard to keep getting funding for it when some of the advocates aren’t promoting it.
Culhane: Advocates are right in arguing that these are poor people that really need a housing voucher. The problem is that we don’t have housing vouchers in enough supply to support this crisis homeless population.
The point of the rapid rehousing program is to get people out of homelessness as fast as possible so they don’t get stuck there. It’s like the emergency room of the homeless system—a crisis intervention program intended to stabilize people.
If someone is coming to you in a crisis, you have to help them. It has to be done in a timely way because every day that a person is homeless they’re exposed to victimization and all the hazards of living an unprotected life on the street. It’s not a long-term intervention, but it’s an intervention that is in reach in terms of the funding available.
Street Sense: You’ve previously said that the disability system is failing.
Culhane: Totally. It’s an absolute crime that we have 50 percent of the homeless population self-report to having a disability. That means there’s something wrong with your disability insurance system. Our social insurance programs for disability are simply inadequate.
Basically, you get $700 a month if you’re relying on disability. That’s $8,400 a year and the poverty level is $14,000. We should not be locking people into an almost-40 percent-below-poverty income just because they have a disability.
We have a disability insurance system in this country that does work. It’s called Social Security Disability Insurance. But it’s only for people who have a work history of enough years of full-time work. Unfortunately, for people who have a mental illness, the onset of that disease is between 18 and 27. So they are unlikely to have accrued enough semesters of work to qualify for SSDI.
When social security was designed in the 1930s, it was basically a welfare program for elderly people who didn’t have a work history. Then it was extended to people who were working-age with a disability, and the most common working-age disability is a severe mental illness. If severe mental illness had its onset at age 40, then it would not be the same issue.
Street Sense: How would you describe the cause and effect relationship between homelessness and mental illness?
Culhane: It’s an affordable housing problem. When there is competition for scarce resources, the people who are the most vulnerable are the ones who are going to lose out.
People with mental illness or other disabilities have a harder time competing in that marketplace because it’s harder to identify places to live, to get landlords to accept them, and to access treatment, so they are at multiple disadvantage.
Mental illness is an episodic condition. Their homelessness is occurring usually as a part of a psychiatric crisis. Sometimes people have serious psychotic symptoms and other times they go into remission, go on medication, and are able to manage the disease. If that doesn’t sustain, then they have crises—it’s the nature of the disease. And so, they get hospitalized often for long periods of time. It’s very disruptive. You lose your social connections, your job, your apartment. That often triggers homelessness.
Street Sense: Where is the field of homelessness heading?
Culhane: The field has gone in the wrong direction. They want to only serve expensive homeless people so that we can save Medicaid money. And I don’t think that the public is as interested in saving Medicaid money as they are in more efficiently using the money to serve more people effectively. From an insurance perspective, you don’t want to have only sick people enrolled in your program. You want to spread the savings over a larger group so that you’re pooling the benefit just like you pool the risk.
It’s not a sound actuarial perspective to focus on the expensive people once they become expensive. We really should be targeting the people who are at risk of being a life-long, high-cost burden on society because they’re not housed. If we have to make the economic argument to persuade people that this is a morally important obligation, so be it. But obviously, it’s more than money. It’s about valuing life.
What’s going to bear watching is the politics that emerge around autism. The number of people coming into young adulthood with autism is growing dramatically. These are folks who are quite similar to people with severe mental illness in the sense that they have cognitive challenges. In a place like Pennsylvania, the number of autistic adults in their 20s is going to go from about 7,000 to over 20,000 in the next ten years. There’s a huge housing component to that.
This interview has been edited and condensed.
